Women & ACL Injuries: Know Risks, Steps for Prevention
August 10, 2021
Whether you’re a casual jogger or elite athlete, you’re at risk for an injury to your anterior cruciate ligament (ACL). If you’re a woman, you are at even greater risk for these injuries.
But there are steps you can take to prevent them.
“Among athletes, women are more than twice as likely to have an ACL injury than men,” says Nithin Natwa, M.D., a sports medicine specialist and primary care physician at Henry Ford Health System. “Once you have an ACL injury, you are at greater risk for having further soft tissue injuries in the future. That’s why it is important to prevent these injuries and follow your treatment plan if injured.”
What Is An ACL Injury?
An ACL injury is a strain or tear in the ACL, one of the four major ligaments that support the knee so it can flex and bend. The ACL is a strong band of tissue that helps connect your thigh bone (femur) to your shin bone (tibia). “An ACL injury usually occurs without contact when you turn suddenly while running or land off-balance on one leg. These actions overload the knee joint and cause the ACL to be torn,” says Dr. Natwa.
In the United States, 100,000 people have ACL injuries each year. Anyone can experience an ACL injury, though athletes participating in sports like football, basketball, soccer and gymnastics are at highest risk. And summer is a peak time for outdoor sports injuries.
Seek immediate care if you have any of these signs of an ACL injury:
• An audible “pop” in the knee
• Intense knee pain and rapid-onset swelling (within hours)
• Loss of range of motion
• An unstable feeling or locking of your knee
The most common treatment for ACL injuries is surgery followed by physical therapy. After treatment, you can expect to return to normal activities in 6 to 9 months. However, peak athletic performance can take up to two years.
Why Are Women At Higher Risk For ACL Injuries?
According to Dr. Natwa, the differences in athletic training techniques for males versus females have left women at greater risk for ACL injuries. “There has been more emphasis on overall conditioning and mechanics for boys participating in sports compared to girls,” he says.
As a result, women are at greater risk for ACL tears and sprains due to:
• Differences in neuromuscular control: Without conditioning from an early age, women may not have the same ability to land and perform athletic motions that men do. For example, women are at higher risk for an ACL injury after landing from a jump.
• Strength imbalance for muscles that support the knee: Female athletes tend to have more defined quadriceps muscles but weaker hamstrings than men, putting them at greater risk for injury.
According to Dr. Natwa, there are many theories about women’s risk for ACL injury that lack scientific evidence, including:
• Width of the pelvis: Some people have suggested that the wider width of a woman’s pelvis puts more pressure on the knee joint and increases the risk for injury. However, this difference has not been shown to impact a women’s risk for ACL tears or sprains.
• Knee anatomy: The ACL runs through a section of the femur called the intercondylar notch. Women tend to have a narrower notch than men. Regardless of gender, individuals who possess smaller notch dimensions appear to be at greater risk for injury than individuals with larger notches.
• Hormones: Men and women have different hormone levels. But there is currently no concrete evidence that female hormones place women at higher risk for ACL injures.
Steps To Prevent ACL Injuries – Conditioning Early, Often
“The best way to prevent ACL injuries is to begin and maintain regular conditioning exercises at an early age,” Dr. Natwa says. “The more frequently you engage in proper exercises, the lower your risk for injury.”
Consult with a sports medicine specialist, physical therapist or athletic trainer to develop a training routine to prevent ACL and other injuries. Your training program should include exercises that:
• Strengthen the muscles that support your knee: Add strength training to build up your calves, hamstrings and quadriceps muscles. These muscles help stabilize your knee as you move. By strengthening these muscle groups evenly, you can lower your risk for injury.
• Improve overall neuromuscular control: Focus on adding neuromuscular exercises that train your nerves and muscles to react and communicate. For example, you may work on your balance by standing on one leg or sit upright on an exercise ball for short periods of time. And core exercises can strengthen the muscles that support your abdomen and back and help improve your posture as you move. These moves can strengthen your joints and help you learn appropriate balance and technique.
“Exercise really is the best medicine. It can improve your balance and agility as you participate in a sport or prevent injury as you move through your daily activities,” says Dr. Natwa. “Consider adding these exercises to your wellness program.”
Dr. Nithin Natwa is a sports medicine doctor who sees patients at Henry Ford Macomb Health Center in Chesterfield and Henry Ford Macomb Orthopedics and Wound Care in Clinton Township.
Want to learn more? Henry Ford Health System sports medicine experts are treating the whole athlete, in a whole new way. From nutrition to neurology, and from injury prevention to treatment of sports-related conditions, they can give your athlete a unique game plan. To find a sports medicine physician at Henry Ford, visit henryford.com or call 1-800-436-7936.
Stretching Done Right: Easy Tips To Stay Limber
By
Christina Chapski, Ed.D., AT, ATC
Henry Ford Health
November 7, 2023
Stretching is more than just a workout suggestion – it's a vital way to avoid injury and get the most out of your activity. You wouldn’t take your car on a long drive without making sure it’s in tip-top shape, right? So before you work up a sweat, work up a stretch.
One important thing to keep in mind is that dynamic stretching is best. It uses momentum to propel your muscles into an extended range of motion. Unlike static stretching, where you remain in an almost still position, a dynamic warm up is the best way to get your blood flowing and your heart rate pumping.
To get your muscles primed for activity, high knees, "butt kicks" and side shuffling are more effective than standing quad stretches. If you are doing an upright quad stretch, it's best to lean back a little to get the full benefit, since your quads originate from above the hip. Also, remember to always grab the ankle and not the toe.
Here are some other helpful hints on how to warm up the right way:
- For hamstrings: The hamstring muscle attaches to your bones below the knee at the back of the leg, so you want to avoid bending them (which ultimately shortens the muscle you’re trying to stretch). When bending at your back, make sure to keep your spine straight like a table to elongate those muscles. Keep your chin up. If you bend down to touch your toes, there’s no need to hover closer than six inches above the ground – unless you’re able to comfortably do so.
- For pectoral muscles: "Door stretches” offer the best stretch. Simply place your arms out on either side of you as if you were making a “T” with your body. Then, bend your arms up at your elbows so they each form a 90-degree angle. In this position, put your arms on either side of a door frame, with your body within the frame’s opening and walk forward slowly to open up the chest.
- For triceps: Make a gesture like you’re scratching your upper back and be sure to keep your elbows in for maximum benefit.
- For the torso: The iron cross stretch involves putting your arms out at your sides like a “T” and then rotating at your waist side to side. You can also drop down toward the floor and reach for your toes, one side at a time.
Other great tips to add to your stretching repertoire include:
- Don’t forget to keep breathing throughout your stretch. It will help keep your muscle tissue oxygenated.
- Hold each stretch for 10 to 20 seconds, aiming for three repetitions of each. If you prefer, you can split up your stretching throughout the day, or use props like foam rollers to help ease tension in your muscles and break up knots.
- Listen to your body while stretching. Slight pain is acceptable, but if your muscles start shaking, it's a warning for you to stop.
- Don't give up. Stretching progress can be slow, so comparing your progress to that of others will only discourage you. Pay attention to your own progress. Seeing your body become more flexible when you previously weren’t limber will help keep you motivated and is the ultimate reward.
To find a sports medicine doctor or athletic trainer at Henry Ford, visit henryford.com/athletes. Christina Chapski, Ed.D., AT, ATC, is the director of athletic training and community outreach at Henry Ford Health. Read more of Chapski's articles.